San Diego County MRC and the Red Cross: An Integrated ...
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    San Diego County MRC and the Red Cross: An Integrated ... San Diego County MRC and the Red Cross: An Integrated ... Presentation Transcript

    • San Diego County MRC and the Red Cross: An Integrated Response to Disasters John Hill Director of Disaster Preparedness – San Diego County Medical Society Volunteer Coordinator - San Diego County MRC
    • San Diego County MRC
      • “ Sponsored” by SD County Public Health Services (PHS)
      • Development and organization contracted to SDCMS
      • MRC Coordinators include PHS and EMS staff
      • Volunteers registered with County Office of Emergency Services (OES) as Disaster Service Workers (DSW)
    • Disaster Shelters in San Diego County
      • Operational Area Emergency Plan
      • Annex “G” – Care And Shelter Operations
        • Red Cross provide bulk of Mass Care Services
        • HHSA and PHS will assist Red Cross
        • Provide trained personnel to Mass Care Shelters (PHNs)
    • Disaster Shelters in San Diego County
      • Public Health Nursing provides PHNs
        • Administer first aid following Red Cross protocols
        • Perform health assessments to identify health problems
        • Perform a variety of other health related tasks:
          • Chronic disease monitoring
          • Protect residences from communicable disease
          • Monitor food preps
          • Health education
    • Background
      • Viejas and Julian Fires (2001/2002) - need to open more than 2 Disaster Shelters simultaneously
      • Public Health Nursing agreed to provide some PHNs to be trained on Red Cross Shelter Operations and Protocols
      • Training Program initiated by PHS and Red Cross for the PHNs
    • Background
      • Fall 2003 - Cedar Fires
      • Largest wildfire in California history
      • Within 48 hours Red Cross established 12 Disaster Shelters
      • 85 PHNs worked more than 100 12-hour shifts
    • MRC Status in 2003
      • SDCMS establishing physician volunteer network to assist PHS
      • Working with PHS to submit application for MRC grant
      • Hospital ERs not overwhelmed with victims (except for Burn Unit)
      • Did not realize health situations at shelters
      • Decision made with PHS to not activate volunteers
    • Cedar Fires Debrief
      • RC and PH Nurses encountered large number of medical issues
        • Most didn’t require transport to ER, but did not fall within protocols for treatment at shelter either
        • Huge number of maintenance med prescriptions
        • Medical supply needs such as oxygen/insulin
        • Not out of the norm, but volume was overwhelming
    • Developing the Partnership
      • Brainstorming session
      • County
        • EMS Disaster Coordinator
        • Lead PHN
        • MRC Coordinators
      • Red Cross
        • Disaster Health Services Directors
        • Lead Physician
        • Lead Nurse
    • Developing the Partnership
      • Brainstorming session
        • Educated each other!
        • Discussed what had been needed in fires
        • Discussed what could possibly have been done
        • Discussed liability (RC vs. DSW) to ensure RC immune
        • Discussed RC notification that MRC is needed
        • Next steps
    • Developing the Partnership
      • Public Health Nurses
        • PHS and Red Cross developed training curriculum
          • Red Cross Shelter Operations
          • Red Cross Disaster Health Services Protocols
          • MRC capabilities and interaction
      • Over 180 PHNs trained
    • Developing the Partnership
      • MRC Advisory Board
      • Red Cross represented by:
        • RC Physician
        • RC Lead Nurse
        • Disaster Health Services Staff
      • MRC adopted Disaster Shelters as a core mission
    • Developing the Partnership
      • Developed notification procedure
      • Developed shelter layout structure
      • Developed client flow to include medical
      • Determined the scope of practice for MRC would be defined during activation by Public Health Officer
      • No need for MOU since already in Annex G
    • Hurricane Katrina
      • 1 st MRC Activation
        • Notified by EMS of possible evacuees arriving in SD
        • Sept 2 nd : conference call w/Red Cross, County, DHS..
        • Sept 3 rd : conference call at 1800 hrs
          • Shelter being established for up to 170 evacuees arriving via plane on Sept 4 th
        • Called 9 volunteers, reached or left message with 8
    • Hurricane Katrina
      • 3 MDs and 5 RNs mustered at shelter
        • MRC/RC established medical location and client flow
        • MRC brought basic medical items
        • RC provided first aid materials, purchased additional supplies and made arrangements to fill prescriptions
        • Deputy PHO assigned to establish scope of practice
    • Hurricane Katrina
      • 80 evacuees arrived approx 1900 hrs
        • All seen by PHNs under RC protocols
        • 35 referred to MRC RNs and MDs
        • Performed medical assessments/exams
        • Wrote prescriptions
        • Referred for follow up
        • 1 transport to ER
        • MRC deactivated at 2230 hrs
    • Hurricane Katrina
      • Throughout week of Sept 5 th prepared for arrival of FEMA flights
      • Red Cross was lead agency
        • MRC/Disaster Health Services developed shelter layout at local university for 600
        • MRC communication system to solicit volunteers
        • Activated 2 MRC MDs to see clients at RC offices
        • MRC pharmacist system to assist filling prescriptions
        • RC established Family Assistance Center (FAC)
    • Hurricane Katrina
      • Sept 10 th to Oct 14 th at FAC
        • 17 physicians volunteered for 79 4-hour shifts
        • 12 nurses volunteered for 21 4-hour shifts
        • 3 pharm techs volunteered for 7 4-hour shifts
        • More than 2300 clients registered at FAC
        • Nurses from RC, PH, and MRC saw 547 under RC protocols
        • 339 needed to be seen by MRC physicians
    • Hurricane Katrina
      • Sept 10 th to Oct 14 th at FAC
      • What did they do?
        • Performed medical assessments/exams
        • Wrote prescriptions
        • Worked with community clinics on referrals/follow up
        • Provided emotional comfort and support
        • Arranged transport to ER or Urgent care if needed
    • Hurricane Katrina
      • Identified a need to better fill prescriptions
        • Some MRC physicians brought sample meds
        • Solicited other MRC and SDCMS physicians
        • MRC pharmacists and pharm techs inventoried
        • Allowed for onsite filling of the common prescriptions
      • Saved the local RC chapter thousands $$
    • Lessons Learned
      • MRC needs more medical supplies than RC or PHN carry
      • Medical location in shelter set up
      • MRC protocols “tailored” for each event
      • Scope of practice set by PHO each time
      • Collaborate with RC on training programs/drills
      • Train MRC nurses and physicians on RC forms
    • Lessons Learned
      • Develop J-I-T training on Shelter Ops
      • Train the PHNs on MRC volunteer management
      • Develop MRC patient forms
      • For long term shelters, establish watch bill system
      • Identify common issues and establish prescription plan
    • John Hill [email_address] 619-285-6452